This episode of Morning Rounds delivers a direct line to critical research on Bronchial Artery Embolization (BAE), the life-saving procedure used to stop massive hemoptysis (coughing up blood).
CF Patient Effectiveness: We analyze a long-term Stanford study on BAE in adults with Cystic Fibrosis (CF), revealing that while BAE is highly effective at stopping the immediate bleed (89% technical success at 30 days), the patient's underlying disease severity remains a major factor in overall survival.
The Crucial Role of Non-Bronchial Arteries: The CF data highlights the need for optimized BAE procedures, showing that nearly 75% of successful procedures involved targeting abnormal vessels recruited from outside the lung's main supply. This suggests a shift toward mandatory pre-procedure imaging (like CT angiography) is necessary for high success rates.
The Rare but Feared Risk: Spinal Cord Infarction (SCI): We break down a massive 9,000-patient Japanese study focused on the risk of SCI, a devastating complication with a low overall prevalence of 0.19%.
Safety vs. Speed: Material Matters: The key finding reveals a statistically significant, more than tenfold difference in SCI risk based on the embolic agent used.
Coils (mechanically placed, controlled): Lowest SCI risk at 0.06%.
Gelatin Sponge (flow-dependent particles): Medium risk at 0.18%.
N-Butyl Cyanoacrylate (NBCA) (liquid glue): Highest risk at 0.71%.
Tune in to discover how these findings demand a critical appraisal of standard clinical practice, balancing the documented safety profile of embolic agents against perceived speed and ease of use.
Based on comments from experts, content on Wysdom, and the article cited below.
Ishikawa H, Ohbe H, Omachi N, Morita K, Yasunaga H. Spinal cord infarction after bronchial artery embolization for hemoptysis: a nationwide observational study in Japan. Radiology. 2021;298(3):673-679. doi:10.1148/radiol.2021202500
Lynne N. Martin, Luke Higgins, Paul Mohabir, Daniel Y. Sze, Lawrence V. Hofmann,
Bronchial Artery Embolization for Hemoptysis in Cystic Fibrosis Patients: A 17-Year Review,
Journal of Vascular and Interventional Radiology, Volume 31, Issue 2, 2020, Pages 331-335, ISSN 1051-0443, https://doi.org/10.1016/j.jvir.2019.08.028.
Martin LN, Higgins L, Mohabir P, Sze DY, Hofmann LV. Bronchial artery embolization for hemoptysis in cystic fibrosis patients: a 17-year review. J Vasc Interv Radiol. 2020;31(2):331-335. doi:10.1016/j.jvir.2019.08.028
